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At the present time stroke risk can be managed with aspirin or warfarin however, the Watchman device can also be used to prevent strokes.
The reason why people who have AF suffer with strokes is because blood clot breaks away from the left atrial appendage (LAA), a small blind ending pouch off the main left atrial chamber. This ‘appendix’ of the heart is not necessary for normal heart function and is routinely removed during certain types of heart surgery. With the LAA removed the chances of having a stroke are greatly reduced and patients do not need to take warfarin.
A minimally invasive, local anaesethic procedure has recently been developed to exclude the LAA from the heart. A purposefully designed plug, compressed within a long thin tube (catheter), is delivered into the heart via the leg. Once the catheter is in position, it can be withdrawn allowing the plug to expand and fill the LAA.
Over the next 6 weeks the body reacts to the plug, causing new tissue to grow over it and therefore permanently occlude the LAA. The most widely used device is called the Watchman and this is being pioneered by the London AF Centre at the London Bridge and St Bartholomew’s Hospitals. A recent clinical trial of 700 patients has demonstrated that the Watchman is as effective as warfarin in preventing stroke.
The Watchman is suitable for patients who have AF and have been advised to take warfarin because they have a high risk of stroke, but are unable to because either they have had a complication eg a dangerous bleed or it causes unpleasant side effects. It can also be considered for patients who for various reasons do not wish to take warfarin.
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